During the past three years the Cleveland Telemedicine system has been designed and built. At this time it links the Veterans Administration Hospital (VA) and Forest City Hospital (FCH) via cables and laser or microwave to a University Hospital (UH) consulting station. It provides consultation from UH for anesthesia services (VA and FCH), ICU and neonatology (FCH). In the next five years we project a multidiscplinary expansion of the system between UH and FCH, increasing the scope of the project in terms of hardware, professional services and practice patterns. Two new remote camera units will be added (one emergency room FCH, one operating room UH) as well as a link to the video tape library in the CWRU Health Sciences Communications Center. Through a new central switching facility, all remote cameras will be connected to the present monitoring unit (Bishop OR Suite) and to two new monitoring units (MacDonald House Delivery and Neonatal Unit, Medical Intensive Care Unit) at University Hospitals. The clinical service expansion will add intensivists from the UH medical ICU, nurse clinicians and obstetricians to those consultants already serving in anesthesiology, neonatology, and surgical intensive care. This complex Telemedicine system bringing the resources of a large University Medical Center to a small community hospital should improve patient care in the small hospital but accomplish this without jeopardizing the independence of the small hospital and without incurrring prohibitive costs. A carefully planned evaluation program will measure the effectiveness of the project. At the end of five years, the project is projected to become self sufficient.